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Abstract This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student's t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

Resumo Este estudo avaliou o efeito preventivo e pós-operatório de dexametasona e ibuprofeno na prevenção da dor, desconforto, edema e interferência na vida diária, em pacientes submetidos ao recobrimento radicular associado a enxerto de tecido conjuntivo subepitelial (CAF + CTG). Vinte pacientes foram divididos aleatoriamente: Grupo AINES: Ibuprofeno 400 mg 60 min antes da cirurgia + Ibuprofeno 400 mg no período pós-operatório e Grupo AIES: 4 mg de dexametasona 60 min antes da cirurgia + Dexametasona 4mg no pós-operatório. A medicação pós-operatória foi administrada 8 e 16 horas pós-cirurgia. Cada paciente recebeu questionários com base na escala numérica NRS-101 (101 pontos numéricos) e perguntas de múltipla escolha (VRS-4) sobre dor / desconforto no período transoperatório, de hora em hora durante 8 h e uma vez por dia durante três dias após a cirurgia. A Escala Visual Analógica (VAS) para análise de edema e interferência na vida diária também foi respondida no 1º, 2º, 3º e 7º dia após a cirurgia. O grau de ansiedade foi estatisticamente avaliado pelo teste do Qui-quadrado. Mann-Whitney e Friedman foram utilizados para os demais questionários. Para o tempo de cirurgia e o número de analgésicos consumidos, o teste t de Student foi aplicado. Os pacientes que utilizaram dexametasona apresentaram uma tendência para menores níveis de dor quando comparados aos indivíduos que ingeriram ibuprofeno, com diferença significativa observada 3 h após o procedimento cirúrgico (p<0,05). A utilização de dexametasona também promoveu menores níveis de edema até ao segundo dia e menor interferência na vida diária no terceiro dia, quando comparada com o ibuprofeno (p<0,05). Concluiu-se que a utilização de dexametasona como medicamento preventivo e pós-operatório mostra ser mais adequado como protocolo medicamentosos para cirurgias de recobrimento radicular com associação de enxerto de tecido conjuntivo.

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This trial evaluated the preemptive and postoperative effect of dexamethasone and ibuprofen on prevention of pain/discomfort, edema and interference in daily life in patients undergoing root coverage combined with subepithelial connective tissue graft (CAF + CTG). Twenty patients were randomly assigned as follows: NSAID Group: 400mg Ibuprofen 60 min preemptive + 400mg Ibuprofen postoperative; or SAID Group: 4mg Dexamethasone 60 min preemptive + 4mg Dexamethasone postoperative. The postoperative medication was administered 8 and 16 h post-surgery. Each patient received questionnaires based on a numeric scale (101-point numeric scale rate [NRS-101]) and multiple choice questions (four-point verbal rating scale [VRS-4]) about trans-operative pain/discomfort, hourly for 8 h after surgery and once a day for three days. A Visual Analogue Scale (VAS) for edema and interference in daily life during the 1st, 2nd, 3rd and 7th day was also answered. The degree of anxiety was rated statistically by the Chi-square test. The Mann-Whitney and Friedman tests were used for the other questionnaires. The surgery time and number of analgesic pills consumed were compared using Student's t-test. Patients who used dexamethasone presented a trend toward less pain when compared to individuals who ingested ibuprofen, with a significant difference observed 3 h after the procedure (p<0.05). The use of dexamethasone also promoted less edema until the 2nd day and lower interference in daily life on the third day when compared with ibuprofen (p<0.05). We concluded that the use of dexamethasone as a preemptive and postoperative medication was more suitable as a drug therapeutic protocol for CAF + CTG.

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Introduction: Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective: To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods: Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion: The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication...

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Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.

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Objetivo: Verificar se o fortalecimento abdominal promove influência na musculatura do assoalho pélvico feminino. Materiais e métodos: Caracterizou-se como um ensaio clínico, realizado com 21 nulíparas, comidade média de 21,7 anos, divididas por conveniência em dois grupos: A (n = 10) – com orientação de contração perineal simultânea à contração abdominal e B (n = 11) – sem orientação de contração perineal. As participantes foram submetidas à avaliação ginecológica e abdominal pré e pós-intervenção por meio de:avaliação funcional do assoalho pélvico (AFA), cones vaginais, perineometria, teste de flexão anterior de tronco, descida de membros inferiores, força de oblíquos e endurance abdominal. O protocolo de fortalecimento abdominal continha três exercícios distintos, associados ou não à contração perineal, com três séries de dez repetições e repouso de 60 segundos, três vezes por semana, em um período de seis semanas. Para a análise estatística foi aplicado o teste t de Student e ANOVA. Resultados: A comparação entre os valores iniciais e finais demonstrou diferenças significativas entre os dois grupos na avaliação do períneo, somente no teste com cones (p = 0,00) e na perineometria (resistência/pressão) (p = 0,03), indicando piora das variáveis no grupo B. Já na avaliação abdominal, o grupo A apresentou resultado significativo em três testes (descida de membros inferiores: p = 0,03, endurance: p = 0,03 e endurance modificado: p = 0,00) comparando-se a somente um do grupo B (endurance: p = 0,01). Conclusões: Sugere-se que a associação de exercícios de fortalecimento abdominal com o perineal pode potencializar o ganho de força e a função desses grupos musculares, e a falta dessa associação pode prejudicar a funcionalidade do assoalho pélvico.

OBJECTIVE: Verify if abdominal strengthen has influence in pelvic floor muscles. MATERIALS AND METHODS: This work consisted on a clinical trial approach twenty-one nulliparous, with average ages of 21,7 years old, divided in two groups: A (n = 10) with perineal contraction orientation simultaneously to abdominal contraction and B (n = 11) with no perineal contraction orientation. The participants were submitted to a gynecological and abdominal assessment pre and post intervention through: pelvic floor functional evaluation, vaginal cones, perineometry, trunk anterior flexion test, inferiors members descent, force of oblique and abdominal endurance. The abdominal strength protocol contained three distinct exercises, associated or not to the pelvic floor contraction, with three series of ten repetitions and sixty seconds of interval, three times a week over a period of six weeks. The Student's t-test and the ANOVA were used for the statistical analysis. RESULTS: The comparison between initial and final values showed significant differences between the two groups in the assessment of the perineum, the test only with cones (p = 0.00) and perineometry (strength/pressure) (p = 0.03), indicating a worsening of the variables in group B. Already in abdominal evaluation, group A showed significant results in three trials (the inferiors members descent: p = 0.03, abdominal endurance: p = 0.03 and modified endurance: p = 0.00) compared to only one group B (addominal endurance: p = 0.01).CONCLUSIONS: Suggest that the combination of abdominal strengthening exercises with perineal may boost the gain in strength and function of these muscle groups and the lack of association may impair the functionality of the pelvic floor.

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